Skip to main content

Sleep disturbance among Arabic breast cancer survivors

Abstract

Background

Sleep disturbance is the most common and distressing cancer symptom that negatively affects the quality of life (QoL). The main objective of this study is to determine the prevalence of sleep disturbance among Arabic women with breast cancer, post-treatment, and assess their sleep disturbance in relation to health-related QoL, demographics and treatment characteristics.

Methods

In this study, cross-sectional data were collected using the Pittsburgh Sleep Quality Index (PSQI: 19-items) and the Functional Assessment of Cancer Therapy-General (FACT-G: 27 items). Demographic information and treatment characteristics were also collected.

Results

A total of 133 women who had been diagnosed with breast cancer agreed to participate in the study. Approximately three-quarters (73.7%; n = 98) of the participants was reported as poor sleepers (PSQI ˃ 5). The worse mean score of the PSQI component was the sleep latency with the highest score (M = 1.71, SD = 0.93). There were significant relationships between poor sleep and treatment (patients receiving both chemotherapy and radiotherapy) and with comorbidities (asthma, anaemia, hypertension/heart failure, diabetes/heart diseases) (P < 0.05). Those experiencing poor sleep had the lowest QoL among the cancer patients.

Conclusion

Sleep disturbance is a significant problem for Arabic patients diagnosed with breast cancer. The result suggests that sleep disturbance should be routinely assessed in clinical settings. Further research should develop an intervention for management to reduce sleep disturbance and improve sleep quality in cancer patients.

This is a preview of subscription content, access via your institution.

Fig. 1

Data Availability

The corresponding author has full control of all primary data. Primary data is available on request.

References

  1. Berger AM (2009) Update on the state of the science: sleep-wake disturbances in adult patients with cancer. Oncol Nurs Forum 36:E165–E177. https://doi.org/10.1188/09.ONF.E165-E177

    Article  PubMed  Google Scholar 

  2. Otte JL, Carpenter JS, Russell KM, Bigatti S, Champion VL (2010) Prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors. J Pain Symptom Manag 39:535–547. https://doi.org/10.1016/j.jpainsymman.2009.07.004

    Article  Google Scholar 

  3. Berger AM, Parker KP, Young-McCaughan S, Mallory GA, Barsevick AM, Beck SL, Carpenter JS, Carter PA, Farr LA, Hinds PS, Lee KA, Miaskowski C, Mock V, Payne JK, Hall M (2005) Sleep wake disturbances in people with cancer and their caregivers: state of the science. Oncol Nurs Forum 32:E98–E126. https://doi.org/10.1188/05.ONF.E98-E126

  4. Clark J, Cunningham M, McMillan S, Vena C, Parker K (2004) Sleep-wake disturbances in people with cancer part II: evaluating the evidence for clinical decision making. Oncol Nurs Forum 31:747–771. https://doi.org/10.1188/04.ONF.747-771

    Article  PubMed  Google Scholar 

  5. Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3:310–318. https://doi.org/10.1016/S2213-2600(15)00043-0

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. Lowery-Allison AE, Passik SD, Cribbet MR, Reinsel RA, O'Sullivan B, Norton L, Kirsh KL, Kavey NB (2018) Sleep problems in breast cancer survivors 1–10 years posttreatment. Palliat Support Care 16:325–334. https://doi.org/10.1017/S1478951517000311

    Article  PubMed  Google Scholar 

  7. Ness S, Kokal J, Fee-Schroeder K, Novotny P, Satele D, Barton D (2013) Concerns across the survivorship trajectory: results from a survey of cancer survivors. Oncol Nurs Forum 40:35–42. https://doi.org/10.1188/13.ONF.35-42

    Article  PubMed  Google Scholar 

  8. National Institutes of Health (2011) National institutes of health sleep disorders research plan. National Institutes of Health, Maryland

    Google Scholar 

  9. Berger AM, Matthews EE, Aloia MS (2018) Sleep and cancer. In: Olver I (ed) The MASCC textbook of cancer supportive care and survivorship. Springer International Publishing, Cham, pp 53–65

    Chapter  Google Scholar 

  10. Otte JL, Davis L, Carpenter JS, Krier C, Skaar TC, Rand KL, Weaver M, Landis C, Chernyak Y, Manchanda S (2016) Sleep disorders in breast cancer survivors. Support Care Cancer 24:4197–4205. https://doi.org/10.1007/s00520-016-3247-6

    Article  PubMed  Google Scholar 

  11. Sateia MJ (2014) International classification of sleep disorders. Chest 146:1387–1394

    Article  PubMed  Google Scholar 

  12. American Academy of Sleep Medicine (ed) (2014) International classification of sleep disorders–third edition (ICSD-3), 3rd edn. American Academy of Sleep Medicine, Darien

    Google Scholar 

  13. Horesh U, Cotter WM (2016) Current research on linguistic variation in the Arabic-speaking world. Lang Ling Compass 10:370–381

    Article  Google Scholar 

  14. Buysse DJ, Reynolds CF, Monk TH et al (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    CAS  Article  PubMed  Google Scholar 

  15. Al Maqbali M, Hughes C, Gracey J et al (2020) Validation of the Pittsburgh Sleep Quality Index (PSQI) with Arabic cancer patients. Sleep Biol Rhythms 0:1–7. https://doi.org/10.1007/s41105-020-00258-w

    Article  Google Scholar 

  16. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J (1993) The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579. https://doi.org/10.1200/JCO.1993.11.3.570

    CAS  Article  PubMed  Google Scholar 

  17. Webster K, Cella D, Yost K (2003) The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System: properties, applications, and interpretation. Health Qual Life Outcomes 1:1–7. https://doi.org/10.1186/1477-7525-1-79

    Article  Google Scholar 

  18. Al Maqbali M, Hughes C, Gracey J et al (2020) Psychometric properties of the Arabic version of the Functional Assessment of Chronic Illnesses Therapy–Fatigue in Arabic cancer patients. J Pain Symptom Manag 59:130–138.e2. https://doi.org/10.1016/j.jpainsymman.2019.10.008

    Article  Google Scholar 

  19. Mansano-Schlosser TC, Ceolim MF, Valerio TD (2016) Sleep quality in women with breast cancer: an integrative review. Int Arch Med 9:1–17. https://doi.org/10.3823/2230

    Article  Google Scholar 

  20. Abrahams HJG, Gielissen MFM, Verhagen CAHHVM, Knoop H (2018) The relationship of fatigue in breast cancer survivors with quality of life and factors to address in psychological interventions: a systematic review. Clin Psychol Rev 63:1–11. https://doi.org/10.1016/j.cpr.2018.05.004

    CAS  Article  PubMed  Google Scholar 

  21. Klyushnenkova EN, Sorkin JD, Gallicchio L (2015) Association of obesity and sleep problems among breast cancer survivors: results from a registry-based survey study. Support Care Cancer 23:3437–3445. https://doi.org/10.1007/s00520-015-2692-y

    Article  PubMed  PubMed Central  Google Scholar 

  22. Otte JL, Payne JK, Carpenter JS (2011) Nighttime variability in wrist actigraphy. J Nurs Meas 19:105–114

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL (2017) Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 13:307–349. https://doi.org/10.5664/jcsm.6470

    Article  PubMed  PubMed Central  Google Scholar 

  24. Schreier AM, Johnson LA, Vohra NA, Muzaffar M, Kyle B (2019) Post-treatment symptoms of pain, anxiety, sleep disturbance, and fatigue in breast cancer survivors. Pain Manag Nurs 20:146–151. https://doi.org/10.1016/j.pmn.2018.09.005

    Article  PubMed  Google Scholar 

  25. Savard J, Ivers H, Savard M-H, Morin CM (2015) Cancer treatments and their side effects are associated with aggravation of insomnia: results of a longitudinal study. Cancer 121:1703–1711. https://doi.org/10.1002/cncr.29244

    Article  PubMed  Google Scholar 

  26. Garland SN, Xie SX, Li Q, Seluzicki C, Basal C, Mao JJ (2017) Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial. Menopause N Y N 24:517–523. https://doi.org/10.1097/GME.0000000000000779

    Article  Google Scholar 

  27. Ancoli-Israel S (2015) Sleep disturbances in cancer: a review. Sleep Med Res 6:45–49. https://doi.org/10.17241/smr.2015.6.2.45

    Article  Google Scholar 

  28. Budhrani PH, Lengacher CA, Kip K, Tofthagen C, Jim H (2015) An integrative review of subjective and objective measures of sleep disturbances in breast cancer survivors. Clin J Oncol Nurs 19:185–191. https://doi.org/10.1188/15.CJON.185-191

    Article  PubMed  Google Scholar 

  29. Costa AR, Fontes F, Pereira S, Gonçalves M, Azevedo A, Lunet N (2014) Impact of breast cancer treatments on sleep disturbances - a systematic review. Breast Edinb Scotl 23:697–709. https://doi.org/10.1016/j.breast.2014.09.003

    Article  Google Scholar 

  30. Aricò D, Raggi A, Ferri R (2016) Cognitive behavioral therapy for insomnia in breast cancer survivors: a review of the literature. Front Psychol 7. https://doi.org/10.3389/fpsyg.2016.01162

  31. Banthia R, Malcarne VL, Ko CM, Varni JW, Sadler GR (2009) Fatigued breast cancer survivors: the role of sleep quality, depressed mood, stage, and age. Psychol Health 24:965–980. https://doi.org/10.1080/08870440802110831

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ziner KW, Sledge GW, Bell CJ, Johns S, Miller KD, Champion VL (2012) Predicting fear of breast cancer recurrence and self-efficacy in survivors by age at diagnosis. Oncol Nurs Forum 39:287–295. https://doi.org/10.1188/12.ONF.287-295

    Article  PubMed  PubMed Central  Google Scholar 

  33. Henneghan AM, Carter P, Stuifbergan A, Parmelee B, Kesler S (2018) Relationships between self-reported sleep quality components and cognitive functioning in breast cancer survivors up to 10 years following chemotherapy. Psychooncology 27:1937–1943. https://doi.org/10.1002/pon.4745

    Article  PubMed  Google Scholar 

  34. Schmidt ME, Wiskemann J, Steindorf K (2018) Quality of life, problems, and needs of disease-free breast cancer survivors 5 years after diagnosis. Qual Life Res 27:2077–2086. https://doi.org/10.1007/s11136-018-1866-8

    Article  PubMed  Google Scholar 

  35. Irwin MR, Olmstead R, Carroll JE (2016) Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation. Biol Psychiatry 80:40–52. https://doi.org/10.1016/j.biopsych.2015.05.014

    Article  PubMed  Google Scholar 

  36. Hopko DR, Lejuez CW, Ryba MM, Shorter RL, Bell JL (2016) Support for the efficacy of behavioural activation in treating anxiety in breast cancer patients. Clin Psychol 20:17–26. https://doi.org/10.1111/cp.12083

    Article  Google Scholar 

  37. Peoples AR, Roscoe JA, Block RC, Heckler CE, Ryan JL, Mustian KM, Janelsins MC, Peppone LJ, Moore DF Jr, Coles C, Hoelzer KL, Morrow GR, Dozier AM (2017) Nausea and disturbed sleep as predictors of cancer-related fatigue in breast cancer patients: a multicenter NCORP study. Support Care Cancer 25:1271–1278. https://doi.org/10.1007/s00520-016-3520-8

    Article  PubMed  Google Scholar 

Download references

Code availability

N/A.

Funding

Graduate Research Grants (GRG), Ministry of Higher Education, Research and Innovation, Oman.

Author information

Authors and Affiliations

Authors

Contributions

A.M. completed the data collection, statistical support, and provided analysis and conceptualization and design and the manuscript preparation.

Corresponding author

Correspondence to Mohammed Al Maqbali.

Ethics declarations

Ethics approval

The study was approved by the local ethics committee.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

N/A.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Al Maqbali, M. Sleep disturbance among Arabic breast cancer survivors. Support Care Cancer 29, 5179–5186 (2021). https://doi.org/10.1007/s00520-021-06088-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-021-06088-x

Keywords

  • Sleep disturbance
  • Arabic
  • Breast cancer
  • Quality of life
  • Survivors
  • PSQI